• Summary date: Mar 28 2019 - More information

    Enacts GS 58-3-226, Overpayment, retroactive denials, underpayments, and nonpayment; health benefit plans. Recodifies GS 58-3-225(h) as subsection (b) of GS 58-3-226, as enacted. Amends GS 58-3-226, as enacted, as follows, expanding the existing provisions to include retroactive denials of previously paid claims. Requires insurers to give the health care provider or health care facility written notice at least 30 days before an insurer retroactively denies a previously paid claim. Now requires the retroactive denial of a previously paid claim, the recovery of overpayments, or the offsetting of future payments under the subsection to be made within six months (was, two years) after the date of the original claim, unless one of the provided exceptions apply. Adds to the exceptions instances in which the claim was subject to coordination of benefits with another insurer, in which case the time period is extended to 18 months, or instances in which the claim submitted was a duplicate claim. Now requires recovery of underpayments or nonpayments by a health care provider or health care facility to be made within six month (was, two years) after the date of the original claim adjudication, unless as previously specified.

    Makes further conforming, clarifying, and technical changes. Applies to claims submitted on or after October 1, 2019.

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